Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation

Ku, Elaine; McCulloch, Charles E.; Roll, Garrett R.; Posselt, Andrew M.; Grimes, Barbara; Johansen, Kirsten L.

doi:10.1111/ajt.16779

Cited by 10 publications

(14 citation statements)

References 30 publications

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“…Finally, the same discourse regarding discrimination could be raised with regards to high BMI recipients who are denied access to the waiting list because of their body weight only. From the present meta-analysis, the four studies investigating the effect of recipient BMI on the post-transplantation one-year recipient and graft survival [ 28 , 29 , 30 , 31 ] found no significant difference in obese and non-obese recipients ( p = 0.28); therefore, even if it is true that bridge interventions, such as bariatric surgery [ 45 ], are increasingly being adopted to overcome this barrier, we think that obese patients should have the same chance as their non-obese counterparts, at least for LD renal transplantation. We also believe that obesity, as a metabolic and systemic disease, leads to higher AR and DGF rates, as per our findings; therefore, an additional effort trying to maximize all the adding risk factors to graft and patient loss is advisable, with a tailored immunosuppression [ 7 ].…”

Section: Discussionmentioning

confidence: 86%

The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis

Bellini

Nozdrin

Pengel

et al. 2021

JCM

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Background and Aims: Recipient demographics affect outcomes after kidney transplantation. The aim of this study was to assess, for kidneys retrieved from living donors, the effect of recipient sex, ethnicity, and body mass index (BMI) on delayed graft function (DGF) and one-year graft function, incidence of acute rejection (AR), and recipient and graft survivals. Methods: A systematic review and meta-analysis was performed. EMBASE and MEDLINE databases were searched using algorithms through Ovid. Web of Science collection, BIOSIS, CABI, Korean Journal database, Russian Science Citation Index, and SciELO were searched through Web of Science. Cochrane database was also searched. Risk of bias was assessed using the NHBLI tools. Data analysis was performed using Revman 5.4. Mean difference (MD) and risk ratio (RR) were used in analysis. Results: A total of 5129 studies were identified; 24 studies met the inclusion criteria and were analysed. Female recipients were found to have a significantly lower serum creatinine 1-year-post renal transplantation (MD: −0.24 mg/dL 95%CI: −0.18 to −0.29 p < 0.01) compared to male recipients. No significant difference in survival between male and female recipients nor between Caucasians and Africans was observed (p = 0.08). However, Caucasian recipients had a higher 1-year graft survival compared to African recipients (95% CI 0.52−0.98) with also a lower incidence of DGF (RR = 0.63 p < 0.01) and AR (RR = 0.55 p < 0.01). Recipient obesity (BMI > 30) was found to have no effect on 1-year recipient (p = 0.28) and graft survival (p = 0.93) compared to non-obese recipients although non-obese recipients had a lower rate of DGF (RR = 0.65 p < 0.01) and AR (RR = 0.81 p < 0.01) compared to obese recipients. Conclusions: Gender mismatch between male recipients and female donors has negative impact on graft survival. African ethnicity and obesity do not to influence recipient and graft survival but negatively affect DGF and AR rates.

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Section: Discussionmentioning

confidence: 86%

The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis

Bellini

Nozdrin

Pengel

et al. 2021

JCM

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“…In addition, there were one prospective and four retrospective comparative studies in kidney transplant candidates from the USA [ 56 , 67–70 ]. Two studies covered a multidisciplinary weight-management program [ 63 – 65 ], two covered laparoscopic sleeve gastrectomy [ 56 , 67 ], one covered Roux-en-Y gastric bypass [ 68 ] and two reported on different bariatric procedures [ 66 , 69 , 70 ]. All studies had a high risk of confounding bias and, with the exception of one study [ 70 ], the design was such that the treatment effect on major clinical endpoints such as patient and graft survival could not be assessed.…”

Section: Chapter 4 What Are the Benefits And Harms Of Interventions Aimed At Weight Loss In Kidney Transplant Candidates With Eskd?mentioning

confidence: 99%

“…Two studies covered a multidisciplinary weight-management program [ 63 – 65 ], two covered laparoscopic sleeve gastrectomy [ 56 , 67 ], one covered Roux-en-Y gastric bypass [ 68 ] and two reported on different bariatric procedures [ 66 , 69 , 70 ]. All studies had a high risk of confounding bias and, with the exception of one study [ 70 ], the design was such that the treatment effect on major clinical endpoints such as patient and graft survival could not be assessed. One large study, which was based on Medicare registry data and was focussed on patients with ESKD, did not provide data on the time on the waiting list and on post-transplantation follow-up, but did report transplantation rates [ 66 ].…”

Section: Chapter 4 What Are the Benefits And Harms Of Interventions Aimed At Weight Loss In Kidney Transplant Candidates With Eskd?mentioning

confidence: 99%

“…One recent study by Ku et al . [ 70 ], on a population with Medicare coverage, compared 194 patients with a history of Roux-en-Y gastric bypass at the time of transplantation with 12 250 controls with a median follow-up of 1 year. The study did not find any association between Roux-en-Y gastric bypass and the rate of patient survival, graft failure, 30-day post-transplant hospital readmission and acute rejection.…”

Section: Chapter 4 What Are the Benefits And Harms Of Interventions Aimed At Weight Loss In Kidney Transplant Candidates With Eskd?mentioning

confidence: 99%

“…A recent study by Ku et al . [ 70 ] compared 190 patients with a history of sleeve gastrectomy at the time of transplantation with 12 250 controls. Sleeve gastrectomy was associated with a 60% reduction of graft failure, whereas it did not affect patient survival, post-transplant 30-day readmission rate and acute rejection rate.…”

Section: Chapter 4 What Are the Benefits And Harms Of Interventions Aimed At Weight Loss In Kidney Transplant Candidates With Eskd?mentioning

confidence: 99%

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Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the DESCARTES Working Group of ERA

Oniscu

Abramowicz

Bolignano

et al. 2021

Nephrology Dialysis Transplantation

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The clinical practice guideline ‘Management of obesity in kidney transplant candidates and recipients’ was developed to guide decision making in caring for people with end-stage kidney disease living with obesity. The document considers the challenges in defining obesity, weighs interventions for treating obesity in kidney transplant candidates as well as recipients and reflects on the impact of obesity on the likelihood of waitlisting as well as its effect on transplant outcomes. It was designed to inform management decisions related to this topic and provide the backdrop for shared decision making. This guideline was developed by ERA's Descartes working group on Transplantation. The group was supplemented with selected methodologists to supervise the project and provide methodological expertise in guideline development throughout the process. The guideline targets any health care professional treating or caring for people with end-stage kidney disease being considered for kidney transplantation or having received a donor kidney. This includes nephrologists, transplant physicians, transplant surgeons, general practitioners, dialysis and transplant nurses. Development of this guideline followed an explicit process of evidence review. Treatment approaches and guideline recommendations are based on systematic reviews of relevant studies, and appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Limitations of the evidence are discussed, and areas of future research are presented.

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Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS)

De Luca,

Shikora,

Eisenberg

et al. 2024

OBES SURG

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The 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for Metabolic and Bariatric Surgery (MBS), replacing the previous guidelines established by the NIH over 30 years ago. The evidence supporting these updated guidelines has been strengthened to assist metabolic and bariatric surgeons, nutritionists, and other members of multidisciplinary teams, as well as patients. This study aims to assess the level of evidence and the strength of recommendations compared to the previously published criteria. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-024-07370-7.

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Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation

Cited by 10 publications

References 30 publications

The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis

The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis

Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the DESCARTES Working Group of ERA

Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS)

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